European Spine Journal最新文献

{"title":"Impact of growth on spinal biomechanics and tether force in VBT: a simulation study.","authors":"Jil Frank, Miguel Pishnamaz, Per David Trobisch, Frank Hildebrand, Maximilian Praster","doi":"10.1007/s00586-025-08738-8","DOIUrl":"https://doi.org/10.1007/s00586-025-08738-8","url":null,"abstract":"<p><strong>Purpose: </strong>Vertebral Body Tethering (VBT) allows correction of scoliosis while preserving the spinal mobility. Despite an increasing availability of data on clinical experience and surgical techniques, there is still a lack of knowledge on the underlying biomechanics, specifically when considered in combination with growth. Therefore, the purpose of this study is to develop a growing flexible spine model to investigate spinal biomechanics after VBT surgery.</p><p><strong>Methods: </strong>A multi-body simulation approach was chosen. A growing, flexible thoracolumbar VBT spine model was developed to analyze the spinal biomechanics during various physiological movements and growth. The model includes a flexible spine with a VBT device and a musculoskeletal system. Therefore, the resulting tether tension and intervertebral compression force can be calculated with respect to the human anatomy and material properties of the VBT device.</p><p><strong>Results: </strong>During growth, the tether and compression forces increase continuously with the highest forces between L1 and L2. The highest tether force is measured at 50° lateral bend at 200 N pre-tension. The compression forces in a tethered spine are during adolescence up to twice higher than in a healthy spine.</p><p><strong>Conclusion: </strong>The simulated biomechanical data provides insight into the forces exerted on the spine during various physiological movements and the remaining growth. They are consistent with previously published clinical data and underlie the finding that age at surgery or residual growth doesn't greatly affect tether forces. During growth, however, intervertebral compression forces increase.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Answer to the letter to the editor of s. biswas, et al. concerning \"machine learning in predicting cauda equina imaging outcomes - a solution to the problem\" by r. sun et al. (eur spine J [2025]: doi.org/10.1007/s00586-024-08591-1).","authors":"Marcin Czyz","doi":"10.1007/s00586-025-08782-4","DOIUrl":"https://doi.org/10.1007/s00586-025-08782-4","url":null,"abstract":"","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Flexibility radiographs in pediatric spine surgery are often used but lack consistency.","authors":"Hirofumi Kusumoto, Tyler A Tetreault, Michael J Heffernan, Paul D Sponseller, Kenneth M C Cheung, Jaime A Gomez, Steven W Hwang, Purnendu Gupta, Lindsay M Andras","doi":"10.1007/s00586-025-08740-0","DOIUrl":"https://doi.org/10.1007/s00586-025-08740-0","url":null,"abstract":"<p><strong>Purpose: </strong>Despite agreement on the importance of spinal curvature flexibility in surgical decision making, there is no consensus regarding optimal radiographic assessment and how this impacts care. We sought to further understand traction film indications and techniques.</p><p><strong>Methods: </strong>A nine-question survey was administered to 194 members of the Pediatric Spine Study Group (PSSG). The survey aimed to elucidate flexibility radiograph practices of pediatric spine surgeons and how these results inform operative plans and timing.</p><p><strong>Results: </strong>Ninety-six of 194 (49.5%) respondents were included in the analysis. 96.9% (93/96) performed radiographic assessment of curve flexibility. Amongst these surgeons, roughly half (52.7%, 49/93) do so for surgical planning only (level selection, osteotomies, construct type, etc.), while 45.2% use them for both surgical planning and surgical timing. Radiographs performed included: supine traction (68.8%, 64/93), supine bending (61.3%, 57/93), standing bending (39.8%, 37/93), supine without traction (20.4%, 19/93), and other (21.5%, 20/93). Supine traction films were typically performed by one person holding the legs and one pulling the arms (62.5%, 40/64) or pulling the chin or head (23.4%, 15/64). Traction is routinely applied by physicians (48.4%, 45/93), radiology technicians (39.8%, 37/93), and physician assistants (20.4%, 19/93). Nearly half (45.2%, 45/93) of surgeons feel that traction films are not a consistent or reproducible measure within their department, and 68.8% (64/93) feel that these films are not reproducible across institutions.</p><p><strong>Conclusion: </strong>The marked variability observed amongst institutional practices and concerns about reproducibility within and across departments warrant the development of a more standardized method to assess curve flexibility.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143662947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating surgical interventions for low-grade degenerative lumbar spondylolisthesis: a network meta-analysis of decompression alone, fusion, and dynamic stabilization.","authors":"Yize Zhao, Yong Huang, Zhe Wang, Yueming Song, Ganjun Feng","doi":"10.1007/s00586-025-08788-y","DOIUrl":"https://doi.org/10.1007/s00586-025-08788-y","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to investigate which of the decompression alone (DA), decompression with fusion (DF), and decompression with dynamic stabilization (DS) produced the most favorable outcome for patients with low-grade degenerative lumbar spondylolisthesis (LDLS).</p><p><strong>Material and method: </strong>Pubmed, Embase, Cochrane, and Web of Science were searched for all studies published before October 1, 2023. A review and data analysis of all randomized controlled trials (RCTs) of three interventions was performed by Stata (version 17.0) and Review Manager (version 5.4).</p><p><strong>Result: </strong>21 RCT studies with 3192 patients were included in the network meta-analysis. DA was superior to DF (MD = -92.05, P < 0.05; MD = -295.57, P < 0.05; MD = -2.19, P < 0.05; RR = 0.54, P < 0.05, respectively) and DS (MD = -35.69, P < 0.05; MD = -100.7, P < 0.05; MD = -295.57, P < 0.05; MD = -2.19, P < 0.05; RR = 0.54, P < 0.05, respectively) in reducing operative time, intraoperative blood loss, length of hospital stay, and postoperative adverse events. DS was superior to DF in reducing operative time, intraoperative blood loss, and length of hospital stay (MD = -56.35, P < 0.05; MD = -194.84, P < 0.05; MD = -1.12, P < 0.05, respectively). DF was superior to DA in reducing reoperations (RR = 0.55, p < 0.05). DF was superior to DA (MD = -1.44, p < 0.05) and DS (MD = -0.41, p < 0.05) in controlling the progression of olisthesis.</p><p><strong>Conclusion: </strong>DA was the most favorable treatment for LDLS, reducing operative time, bleeding, hospital stay, and postoperative complications. DF outperformed DA in reducing reoperation rates. Although DS showed benefits in operative time and bleeding compared to DF, it did not offer a significant advantage over DA.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143662825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex-based differences in biomechanical function for chronic low back pain and how it relates to pain experience.","authors":"Erin Archibeck, Irina Strigo, Aaron Scheffler, Abel Torres-Espin, Karim Khattab, Pavlos Silvestros, Robert Matthew, Caitlin Regan, Paul Hodges, Conor O'Neill, Jeffrey Lotz, Grace O'Connell, Jeannie Bailey","doi":"10.1007/s00586-025-08730-2","DOIUrl":"https://doi.org/10.1007/s00586-025-08730-2","url":null,"abstract":"<p><strong>Purpose: </strong>The relationship between pain experience and biomechanical impairment in chronic low back pain (LBP) is unclear. Among the broader pain literature, sex-based differences in pain experience have been established. However, it is unknown if sex-based differences in pain experience relates to compromised movement patterns for patients with chronic LBP. This study examined sex differences and whether there are sex-based associations between pain experience and biomechanical function in patients with chronic LBP.</p><p><strong>Methods: </strong>To capture the biomechanical variability among LBP patients, we quantified full-body movement quality based on the extent that 3D postural trajectories deviated from matched controls during a sit-to-stand task (Kinematic Composite Score, K-Score). For both males and females, the K-Score was compared to pain measures, including patient-reported metrics and quantitative sensory testing (pressure pain threshold, PPT).</p><p><strong>Results: </strong>There were significant sex-based differences in pain experience and biomechanical function in patients with LBP. Specifically, males exhibited ~ 8% lower trunk K-Scores, indicating biomechanical function that deviated more from controls when compared to female participants (p < 0.001). However, females exhibited PPT values 29% and 41% lower than males at the control and pain sites, respectively (p < 0.0001). There was a weak but significant negative association between PPT and K-Scores for males (R² = 0.14, p < 0.01), while females lacked an association.</p><p><strong>Conclusion: </strong>Overall, males with LBP exhibited worse movement quality, driven by trunk motion, but higher PPTs. Possible explanations include reduced interoceptive awareness or increased kinesiophobia in males, which may influence movement patterns. This research is an initial step in uncovering the complex relationship between patient-specific factors influencing LBP disability, laying the groundwork for further exploration, and paving the way for improving outcomes with patient-specific treatments.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Untreated symptomatic lumbar spinal stenosis and health-related quality of life: the locomotive Syndrome and Health Outcome in Aizu Cohort Study (LOHAS).","authors":"Takeru Yokota, Kinshi Kato, Miho Sekiguchi, Koji Otani, Takuya Nikaido, Kazuyuki Watanabe, Hiroshi Kobayashi, Ryoji Tominaga, Michiyuki Hakozaki, Takuya Kameda, Yoichi Kaneuchi, Shoji Yabuki, Shin-Ichi Konno, Yoshihiro Matsumoto","doi":"10.1007/s00586-025-08791-3","DOIUrl":"https://doi.org/10.1007/s00586-025-08791-3","url":null,"abstract":"<p><strong>Purpose: </strong>This study compared health-related quality of life (HRQoL) between untreated and conservatively treated patients with symptomatic lumbar spinal stenosis (LSS) using data from the Locomotive Syndrome and Health Outcome in Aizu Cohort Study.</p><p><strong>Methods: </strong>We retrospectively analyzed HRQoL using the SF-12 survey in patients diagnosed with symptomatic LSS via a self-reported history questionnaire. LSS treatment history was confirmed through physician interviews. The study included untreated (UTG) and conservatively treated patients (CTG). One-to-one nearest-neighbor propensity score matching compared patients receiving and not receiving conservative treatment. Propensity scores were calculated using background data: age, sex, height, weight, smoking, difficulty walking 100 m, urinary incontinence during walking, comorbidities, musculoskeletal disease treatment history, and questionnaires (depression screening, low back pain-specific QoL, self-efficacy regarding falls, physical activity assessment, and the 2008 SF-12).</p><p><strong>Results: </strong>In 2008, 376 patients were diagnosed with symptomatic LSS. At the 1-year follow-up, 251 were untreated, 144 received conservative treatment, and 11 underwent lumbar spinal surgery. Before matching, overall HRQoL was lower in the CTG than in the UTG at baseline and 1-year follow-up. Mental health scores in the CTG significantly decreased at the 1-year follow-up. After matching, the median change in mental health scores was significantly lower in the CTG than in the UTG.</p><p><strong>Conclusion: </strong>At baseline and the 1-year follow-up, HRQoL was lower in the CTG compared to the UTG. Additionally, there was no apparent QoL deterioration in the UTG during the 1-year follow-up, even when patients followed their natural medical consultation behaviors.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143662891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and safety of lumbopelvic fixation in spinal metastasis comparing S2 Alar-iliac screw and conventional iliac screw.","authors":"Pawin Akkarawanit, Siravich Suvithayasiri, Borriwat Santipas, Sirichai Wilartratsami, Panya Luksanapruksa","doi":"10.1007/s00586-025-08774-4","DOIUrl":"https://doi.org/10.1007/s00586-025-08774-4","url":null,"abstract":"<p><strong>Purpose: </strong>The clinical issue of lumbosacral metastases (LM) is really significant. This study aims to compare in patients with lumbar pathology (LM) the outcomes of the conventional iliac (CI) screw technique against the S2 alar-iliac (S2AI).</p><p><strong>Methods: </strong>A retrospective review of institutional databases was performed for lumbar metastasis patients. who underwent lumbopelvic fixation, with or without decompression, between April 2014 and April 2022. Demographic information, reoperation rates, operational time, estimated blood loss (EBL), and length of hospital stay (LOS) were collected. Patient-reported outcomes were the Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and EQ-5D-5L, which were examined both before and after surgery.</p><p><strong>Results: </strong>A total of 38 patients were involved in the study, with 21 allocated to the S2AI group and 17 to the CI group. The S2AI group demonstrated a length of stay (LOS) of 13.38 ± 8.35 days, in contrast to 24.35 ± 21.59 days, yielding a p-value of 0.047. The estimated blood loss in the S2AI group exhibited a decrease (592.86 ± 353.92 ml compared to 1073.53 ± 1122.45 ml; P = 0.137), alongside a reduction in operative time (181.19 ± 47.35 min versus 207.06 ± 105.69 min; variance = 0.648). Within the CI group, there were six patients who encountered surgical complications, accounting for 35.3%, while the S2AI group noted an absence of complications. The postoperative outcomes demonstrated a notable enhancement in both cohorts.</p><p><strong>Conclusions: </strong>Compared to CI, S2AI had better reoperation rates, estimated blood loss, operating duration, and length of stay. Both groups improved patient-reported outcomes, but the S2AI group improved significantly three months after surgery.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143662821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Mendelian randomization study to reveal gut-disc axis: causal associations between gut microbiota with intervertebral disc diseases.","authors":"Yuanxin Ge, Huifang Yang, Yang Fu, Jie Zhou, Zilin Cheng, Xiaohong Fan, Yang Yu","doi":"10.1007/s00586-025-08795-z","DOIUrl":"https://doi.org/10.1007/s00586-025-08795-z","url":null,"abstract":"<p><strong>Purpose: </strong>Emerging evidence suggests a link between gut microbiota and intervertebral disc diseases (IDDs); however, the causal relationships remain unclear. This study aimed to evaluate the causal effects of gut microbiota on the risk of cervical disc disorders (CDD), other intervertebral disc disorders (OIDD), pyogenic intervertebral disc infections, and discitis, shedding light on the potential \"gut-disc axis\".</p><p><strong>Methods: </strong>Genetic variation data for 202 gut microbiota taxa were obtained from the Dutch Microbiome Project, and disease outcome data were sourced from the FinnGen consortium. A Mendelian Randomization (MR) approach was employed to assess causal relationships, using genetic variants as instrumental variables. Sensitivity analyses, including tests for pleiotropy, heterogeneity, and reverse causation, ensured robust findings.</p><p><strong>Results: </strong>The study identified 20 gut microbial taxa with significant associations to IDDs. Notably, taxa within the Erysipelotrichaceae family showed consistent protective effects against OIDD after Bonferroni correction (P < 0.05). Associations between several species and specific diseases, such as Alistipes senegalensis with CDD and Ruminococcus lactaris with discitis, were also observed. Sensitivity analyses confirmed no evidence of confounding or reverse causation.</p><p><strong>Conclusion: </strong>This study provides evidence of causal relationships between specific gut microbiota and IDDs, supporting the existence of a \"gut-disc axis.\" The findings suggest that microbial dysbiosis may influence spinal health through systemic inflammation and immune regulation. These insights open new possibilities for microbiota-targeted interventions, such as probiotics or dietary modifications, to prevent or manage IDDs. However, further research is required to validate these therapeutic strategies.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143662818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Answer to the letter to the editor of J. Yao, et al. concerning \"magnetic resonance imaging ultrasonography fusion-guided transforaminal epidural steroid injection: a retrospective cohort\" by Ahmet Sumen, et al. (Eur spine J [2025]: doi.org/10.1007/s00586-025-08705-3).","authors":"Ahmet Sumen, Kubra Neslihan Kurt Oktay","doi":"10.1007/s00586-025-08766-4","DOIUrl":"https://doi.org/10.1007/s00586-025-08766-4","url":null,"abstract":"","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Do all symptomatic adjacent segment diseases (ASD) require surgery? a prognostic classification and predictors of surgical treatment of lumbar ASD.","authors":"Rishi M Kanna, Gnana Prakash, Ajoy Prasad Shetty, Rajasekaran Shanmuganathan","doi":"10.1007/s00586-025-08797-x","DOIUrl":"https://doi.org/10.1007/s00586-025-08797-x","url":null,"abstract":"<p><strong>Introduction: </strong>Symptomatic Adjacent segment disease presents in myriad ways with varying clinic-radiological presentation but the optimal management and the factors that predict need for revision surgery are unclear.</p><p><strong>Methodology: </strong>Consecutive patients (n = 132) who experienced significant back or leg pain after an asymptomatic period (minimum 1 year) following a lumbar fusion were evaluated with dynamic radiographs and MRI. ASD was classified anatomically as proximal (86.3%), distal (12.1%, or combined (1.5%) and, sub-classified pathologically into six sub-types: Type 1: Disc prolapse (17.4%), Type 2: Disc degeneration with intra-discal instability (15.1%), Type 3: Anterolisthesis and facet instability (6.8%), Type 4: Retrolisthesis (25%), Type 5: Stenosis (21.9%) and Type 6: Combined types (13.6%).</p><p><strong>Results: </strong>The mean duration between the index surgery and ASD was 5.9 ± 4.1 years. Surgery was required in 40.9% (54/132). Six factors were highly predictive of surgical treatment for ASD, viz., Diabetes mellitus (OR-4.3, p = 0.007), ASD- disc prolapse (OR 6.3, p = 0.018), ASD intra-discal instability (OR-16.8206, p = 0.003), ASD - anterolisthesis (OR - 8.2998, p = 0.043), Facet angle > 75° (OR 37.6, p = 0.02) and radiculopathy (OR 48.0, p = 0.002). Retrolisthesis was the most benign type as 84.8% patients were managed conservatively (p = 0.016). Among proximal ASD, retrolisthesis was the most common subtype (28.9%) while disc prolapse was the most common subtype in distal ASD 37.5% (p = 0.032).</p><p><strong>Conclusion: </strong>The study classifies the versatile clinic-radiological presentation of ASD, and identifies factors that predicted the development of the different sub-types of ASD. Knowledge about the six clinic-radiological factors that predict the need for surgical treatment in ASD is beneficial.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}